Mitigating and Preparing for H1N1

Frye Regional Medical Center in Hickory, N.C., where I serve as emergency preparedness coordinator, held a press conference regarding the H1N1 flu outbreak on May 1. We did so to educate and reassure the public by explaining the steps we are taking internally and in concert with community public health and health care providers. Though these remarks – which include expert insight from our chief of staff and infectious disease physician – are offered especially to the people of the Hickory Metro area, we hope you may find them of value as we all strive to learn more about mitigating and preparing for the various scenarios that could occur with this outbreak.

The remarks are published in the order in which they were shared at the news conference.

Michael Barrick, Emergency Preparedness Coordinator

Good morning. Frye Regional Medical Center has been closely monitoring the H1N1 flu outbreak for more than a week, as we take very seriously the health and safety of our staff and the people we serve.

For several years, Frye has placed a firm focus on emergency preparedness. As a result, we have a strong team of doctors, clinicians, administrators and support staff in place to respond to various emergencies, including this outbreak. Every day, we are working on our emergency response plans. We have extensive training, drills, analysis and reviews of all of our plans, including those for this outbreak.

However, we wish to take this opportunity to caution the public to remain calm. While this outbreak is serious, this flu is treatable.

There are several steps we have undertaken to prepare for an outbreak in our area. We have been meeting daily with public health officials and other health care providers. We wish to thank the Catawba County Health Department and the North Carolina Department of Public Health for their active, robust response to this development.

Additionally, our team has been meeting daily throughout this week. Medical staff, administrators and clinicians representing various disciplines have participated in these daily meetings to review our plans and to consider contingencies and develop responses for them.

We have already taken several steps in various areas of the hospital to mitigate the impact of the outbreak and to prepare and respond should confirmed cases occur in the Hickory Metro area. We have assessed our inventory of medications and personal protective equipment to ensure supplies are adequate and will continue to do so.

Should you have flu symptoms, which our Chief of Staff will detail momentarily, it is important that you see your family doctor. Should you need to report to our Emergency Department, you may see staff wearing masks, gloves, goggles and gowns. This should not alarm you; rather it should comfort you, as these steps are taken to minimize the risk of spreading the disease.

Frye Regional Medical Center stands ready to serve the people of the Hickory Metro area. Providing them with top-quality healthcare is our objective. Keeping them educated and informed is an important part of that mission.

Kevin R. Clark, D.O., Frye Regional Medical Center Chief of Staff

Good morning. As Chief of Staff of Frye, I take seriously our responsibility to our community – as do all of our employees. Our goal is to provide the level of care that we would expect for any of our family members. Part of that care includes education. So, with a serious disease outbreak facing us, we are taking this opportunity to put this situation in perspective.

There is no doubt this is a serious matter. The World Health Organization would not have placed the Pandemic Alert at its next to highest level if that was not the case. That is why numerous steps are being taken to quickly identify individuals coming to Frye who present with flu symptoms.

We are closely monitoring every patient that enters our emergency department and are taking the proper precautions should a person complain of flu symptoms, which include a fever, lethargy, lack of appetite, and coughing. Additional symptoms could include a runny nose, a sore throat, nausea, vomiting and diarrhea. Also, it is important to remember that we are in the height of the spring allergy season. And, these symptoms could also be signs of an illness that isn’t the flu.

Additionally, it is important to remember that we are still in the annual flu season. So, just because someone complains of the flu or even has the flu, does not mean they have the H1N1 virus. Indeed, it is common for us to diagnose people with the flu this time of year. To date, though, there have been no confirmed cases of the H1N1 flu at Frye.

We simply do not know how this will unfold. It is too early to tell. But whatever the outcome, it is critically important to remember that to date, the disease is treatable. Indeed, we have adequate supplies to treat confirmed cases of the flu, so long as other providers do not prescribe and dispense medicines unnecessarily, causing stockpiles to be depleted. Frye, then, is ready to care for those who seek treatment, but we also wish to emphasize that it is generally best to first visit your family doctor, who is familiar with your medical history.

Our staff’s health is very important to us. They must remain healthy to care for you. So, don’t be alarmed by any protective gear they may be wearing, and please comply with their directions. We deal daily with infectious diseases and do have plans for dealing with an outbreak.

It is important to understand that while we are prepared to provide whatever level of care is needed for this outbreak should it reach the Hickory Metro area, it is also important to remember that should you become ill, you will quite likely be able to recover at home if you follow your doctor’s directions closely.

Grace Auton, M.D., Infectious Disease Physician

Good morning. We are aware that the people of our community are concerned – if not alarmed – by the H1N1 flu outbreak. While people certainly should have a heightened awareness, we do not want them unduly alarmed. So, there are a few details regarding this outbreak I wish to share.

Numerous steps are being taken to track the disease in our county, state, the nation and the world.

Key objectives at the moment include early detection of outbreaks, ensuring rapid intervention, and mitigating further complications. Additionally, teams have been sent to impacted communities, and investigating the causes of the deaths in Mexico is a top priority. The county and state public health agencies are in constant communication with one another, and are in direct contact with the CDC.

Frye Regional Medical Center, through its collaboration with community partners, is aware of vulnerable populations for disease outbreaks. Responding to their needs is part of our preparedness plans.

While the significance of this outbreak should not be underestimated, it is important for the public to understand that hospital and public health workers are monitoring every patient entering our doors.

Most encouraging, there are steps we, as individuals, can take to mitigate the impact of this outbreak upon ourselves, our families, our neighbors, and our communities. First, wash your hands regularly with soap and water, or use alcohol-based sanitizers. Always cover your mouth when you cough or sneeze. Avoid touching your eye, nose or mouth. Try to avoid close contact with sick individuals. If you are a caregiver for a person who is ill, take precautions. There are guidelines on the CDC website. If you are sick, after you are treated, follow the doctor’s directions and stay home.

Every day we practice standard infection prevention procedures to limit the spread of diseases. We are taking seriously the need to be ready. We encourage our neighbors to do so also. In doing so, we can sensibly and calmly prepare for whatever the next weeks and months hold.

Read coverage by the Hickory Daily Record here.

Read coverage by the Newton Observer-News-Enterprise here.

Other key resources:

FAQ on the H1N1 virus
North Carolina Department of Public Health
Centers for Disease Control and Prevention
World Health Organization

Balancing the National Guard’s Role in Disasters

By Michael Barrick

With a new administration in the White House reviewing our nation’s plans for responding to man-made or natural disasters, the role of the U.S. National Guard will undoubtedly be reviewed. While the 2006 congressional study of Hurricane Katrina – A Failure of Initiative: The Final Report of the Select Bipartisan Committee to Investigate the Preparation for and Response to Hurricane Katrina – revealed a startling lack of collaboration and leadership at all levels, it also revealed the readiness of the U.S. National Guard to be a bright spot. However, readiness does not ensure a proper response. Though that ended up being the case during Katrina, the National Guard clearly has a role to play in natural disasters. However, its role must be balanced against the nation’s historical principle that “all disasters begin and end locally.” In short, the Guard must be put to its highest and best use, but not be asked or allowed to cross the line of civilian control of disaster response and recovery.

The greatest strength of the Guard – its disciplined methods and force – turned to be its greatest liability during the response to Hurricane Katrina. However, the blame does not rest with the National Guard or its leaders, for it was ready to deploy; rather civilian authorities charged with understanding its role within the National Response Plan (now the National Response Framework) and with the responsibility for activating the National Guard simply failed to utilize this tremendous asset in a timely manner.

There is no question that the National Guard’s primary mission is to be ready to deploy to combat theaters. “The current heavy reliance on the Army National Guard for oversees operations represents a fundamental change from the Guard’s planned role as a strategic reserve force whose principle role was to deploy in the later stages of a major conflict, if needed” (GAO report, 2005). Yet, despite this primary mission, and even with civil authorities seemingly making questionable decisions regarding the legitimate and legal use of military assets, the National Guard eventually fulfilled its role in the greatest natural catastrophe of our time. In short, the systems were ostensibly in place that would have allowed for a quick, coordinated response by the National Guard – whether operating under the orders of the President or Gulf Coast Governors – if civilian leadership would have been more proactive in calling upon these resources.

While Katrina is but one natural disaster, its scope was so significant as to allow ample opportunities for learning lessons and applying them. First, though, a review of what the National Guard did right in responding to Hurricane Katrina points to the assets that it – and it alone – brings to the tool box of disaster preparedness and response. The Air National Guard rescued 85 civilians from Gulfport, Mississippi in what Lt. Gen. Daniel James III, the Director of the Air National Guard called, “the largest military airlift operation supporting disaster relief in the United States” (A Failure of Initiative, 2006). Additionally, National Guard units provided search and rescue operations, hauled cargo such as sand bags, provided emergency medical treatment and supplied assistance for trauma surgeries. It also patrolled areas subject to looting or unrest, manned checkpoints, supported local law enforcement, provided assistance to those with special needs, and provided security at the Superdome (A Failure of Initiative, 2006).  It also provided logistical support to FEMA and provided high-clearance vehicles and helicopters to aid evacuation efforts.

Still, the ill-coordinated response to Hurricane Katrina by all levels of government has forced a reexamination of the role of the National Guard in disaster response within the United States. Before considering the conclusions from the untold number of assessments of the response to Hurricane Katrina, it is instructive to look at a recent event – Hurricane Ike. Evidence suggests that lessons have been learned. According to the U.S. Northern Command website, the response to Ike included dozens of search and rescue missions, the deployment of the USS Nassau to Galveston, the coordination of relief supplies, pre-positioning of equipment and supplies, and logistical support (USNORTHCOM News). Indeed, the effective use of pre-positioned supplies is a tremendous improvement from the response to Hurricane Katrina. “By the time Katrina made landfall on August 29, 2005, the military was positioned to response with both National Guard and federal forces” (GAO Katrina report, 2006). Yet, DHS Secretary Michael Chertoff and others who could and should have asked for those resources did not do so until well after landfall. The failure to use these resources effectively during Hurricane Katrina is just one example of the challenges facing the National Guard when it is called upon to provide disaster assistance. Because they were deployed but not utilized, commanders lacked situational awareness and were hence hampered in identifying the most critical assets requiring deployment. Another challenge is that a large percentage of National Guardsmen are presently deployed oversees. The draw-down of equipment being utilized in the battle fronts in Iraq and Afghanistan is also having a negative effect. “…states are concerned about the Guard’s ability to perform future domestic missions given its declining equipment status” (GAO Katrina report, 2006).

Also, as Banks has noted, the Department of Defense does not wish to have an expanded role in domestic disaster relief. Echoing this sentiment is Assistant Secretary of Defense Paul McHale, who wrote, “…striking the appropriate balance between the military’s primary warfighting role overseas and the need to support civilian authorities at home is a difficult, but fundamental issue” (GAO Katrina report, 2006).

Conclusion
One finding in “A Failure of Initiative” is debatable. In it, the authors stated, “The most important limit to the military’s ability to manage domestic disaster response is the nation’s traditional reliance on local control to handle incident response.” Essentially, the authors are stating that the problem is systematic. However, none of the other reports supports this conclusion. What they do support is that the people responsible for implementing the systems failed to exercise their roles. Communications breakdowns, bureaucratic layering, turf battles, political considerations, and flat-out incompetence ruled the day. Until each and every system that failed is tested in a manner to allow it to function as intended, it is premature to abandon our firmly-held principle of local and civilian control even while we still utilize the Guard as only it can be. Ultimately, the failures during Hurricane Katrina were caused by responsible parties failing to do what was required of them – to imagine the worst and to prepare for it.

© The Barrick Report and Emergency Preparedness Today,  2009. Contact the author at mbarrick@charter.net.

Lessons from Hurricane Evacuations

By Michael Barrick

Following the wave of hurricanes that overwhelmed the United States Gulf Coast during the late summer of 2005, and out of concern for the need to have effective plans in place to evacuate urban populations in the event of a terrorist attack, the U.S. Department of Transportation, in collaboration with the U.S. Department of Homeland Security, conducted an assessment of the hurricane evacuation plans in the five Gulf Coast states – Alabama, Florida, Louisiana, Mississippi and Texas.

While evacuating urban areas is a real possibility as long as the nation remains at war, it is the Gulf Coast states that have the actual experience of evacuating entire cities, counties and regions. While many mistakes have been exposed during these evacuations, so too have many lessons been learned. However, before a community can apply these lessons to improve their own plans, it is imperative that we first have an understanding of who is responsible for the decisions leading to an evacuation, and what agencies and organizations are essential for support of the operations developed and implemented by the decision-makers.

Primary Responsibility

As with virtually any natural disaster in the United States, the decision to evacuate a community during a disaster is made by emergency management officials at the local level. However, because of the size and scope – not to mention the unpredictable nature of hurricanes – it is folly to think that only local officials could make such a decision. They can not operate independently of adjacent communities that would be impacted by the storm, nor can they act independently of communities that would be receiving evacuees or have them moving through their communities on to safer venues. So, while it is a local decision, it is one that involves more than one locality, and requires input from multiple levels of government, functions, private entities and non-government organizations (NGOs). Ultimately, however, it is up to the emergency manager in each community who, by state statute is the appropriate designee, to make the final decision.

Support for Decision Making

The official that must ultimately be the one person accountable for making the decision to evacuate in face of an approaching hurricane is well-served to call upon as many resources as possible before he or she reaches the “Hurricane Evacuation Decision Time” (Patterson, Tutorial 1.3). Some key partners that the emergency manager will want to call upon include meteorologists with the National Weather Service; transportation officials; emergency response agencies, in particular police because of the need for safety and control; the American Red Cross and other NGOs; and peers in neighboring communities. However, others – while not involved in the initial phases of an evacuation – must also be consulted.

The clearest proof of this are the Emergency Support Functions (ESFs) established under the National Response Framework (NRF). A listing of those functions guides the emergency manager. In short, virtually every one of these 15 functions would be involved in some stage of the evacuation, whether it is preparedness, mitigation, response or recovery. So, the emergency manager should keep in close contact with officials at the local, state and federal level which contribute to each of these functions so that the manager will have a greater level of situational awareness regarding how his or her decision to evacuate will impact not only the population evacuating, but also the agencies providing those functions. In short, are these agencies fully informed and prepared to support the evacuating population?

Top Improvements

Choosing which improvements are the “top two” is difficult because while the plans have been assessed, the implementation of them have not been (though the After Action Reports that are presently being generated in response to the hurricane season of 2008 should soon provide such insight). So, in considering the top improvements in hurricane evacuations discovered through this congressional study, I considered two primary measures. First, which areas have the greatest impact upon morbidity and mortality? Second, which areas allowed for the greatest room for improvement? Considering the five areas that the report identified as the weakest areas of evacuation plans and processes – public communications, serving special needs populations, planning, operations, and sheltering – I considered the subsets in each category as they related to the two measures noted above. The greatest weakness under operations and planning – contraflow (getting people back home after the event) was eliminated as a potential top improvement because it simply does not have a high potential for impacting morbidity and mortality. Under sheltering, the main problem was with animals. Again, this is not a primary concern under that first measure.

Consequently, improvements in public communications and meeting the needs of special populations are the two areas I have identified as why these are the areas which must show – and have shown – the most improvement. That is because improvements in these areas have the greatest potential to reduce morbidity and mortality.

Evidence

So, if assessments are incomplete, how can one state that public communications and meeting special needs populations are the two areas showing the greatest improvement?

First, the “Findings and Recommendations” (Congressional Report) support my conclusions regarding the areas impacting morbidity and mortality. Second, as a result, these two areas have current corrective actions in place, some of which I have personal experience with in my position as an emergency manager. The study reports that “three crosscutting issues…emerged from the study” (page 5-1). First mentioned is the lack of local coordination. This is a communications issue. Second is that evacuation plans do “not adequately address…those with special needs” (page 5-1). Finally, the two intersect in the third finding. “…plans for communicating essential information to those who do not have…special needs generally are not well developed” (page 5-1).

Still, how can one claim that these deficiencies are areas of greatest improvement? First, one can presume that the areas identified as the greatest weaknesses and threats will receive the most attention. Second, corrective actions are in place for these areas. On August 1, 2008, our facility participated in a regional DHS Full Scale Exercise which tested, as key objectives, evacuation plans and responding to special needs populations. Furthermore, The Joint Commission, DHS and other regulatory bodies have made these two areas key focal points for current assessments of emergency management plans for communities and hospitals. Unquestionably, such scrutiny will lead to rapid and measurable improvements in these areas.

Conclusion

Until these plans are more fully tested, and until comprehensive After Action Reports from the 2008 hurricane season (which is not yet over at the time of this writing) are completed, we can speculate that the two areas identified – communications and meeting special needs – are showing the most improvements based on the evidence above. However, further assessments must be conducted and ongoing to validate these claims. Finally, it is arguable that whatever steps are taken will be incomplete, because coastal communities and the nation seem reluctant at this point to take the most obviously beneficial mitigation step – regulating and limiting further coastal development.

References

“Catastrophic Hurricane Evacuation Plan Evaluation: A Report to Congress.” U.S. Department of Transportation, 1 June, 2006.

Patterson, Chip. “Hurricane Evacuation Decision Making” lectures. University of North Carolina. HPM 423.

© The Barrick Report and Emergency Preparedness Today,  2009. Contact the author at mbarrick@charter.net.

Hospital and Health Care Preparedness Report Requires Heeding

Hospital Week a Good Time to Apply Lessons Learned

By Michael Barrick

National Hospital Week is next week, May 11-17. Though the valuable work of the millions of hospital clinicians, physicians, administrators and support staff is certainly worthy of celebration, it is also an opportunity to reflect upon the state of hospital and health care system preparedness for our ever-changing world.

This is not a question I raise. It was raised last week in numerous news reports. On May 5, numerous national news outlets reported that hospitals are simply not prepared to meet the demands of a pandemic or other potential risks such as catastrophic natural hazards or terrorist attacks. The sources of those reports were none other than doctors, researchers and academicians from the Department of Homeland Security, the Centers for Disease Control and Prevention, and the Department of Health and Human Services.

Recognizing that hospitals would be overwhelmed in certain scenarios, these health care leaders issued a wake up call to the public. In speaking with family members and friends as this news was being reported, it was clear that the message had been heard. As a result, people are concerned. That’s good. From concern is born a deeper awareness. That awareness could lead the public to demand that the federal government take a fresh look at disaster statutes like The Stafford Act and other revenue streams for local responders and receivers.

Meanwhile, with this group of health care leaders offering very specific – and startling – recommendations such as not providing care for people over 85 or with severe chronic disabilities should systems be overwhelmed – it is perhaps fitting that hospitals not only celebrate next week; it is also an opportunity to study history in order to defy the predictions of these leading health care experts.

One such way is to examine the sarin nerve gas attacks in Japan in 1995. While terrorist attacks obviously represent different threats than other hazards, this event so overwhelmed local hospitals that its lessons apply to multiple scenarios.

In March of that year, residents of Tokyo using the subway system were victimized by a sarin nerve gas terrorism attack. Perpetrated by the Aum Shinrikyo cult under the leadership of Chizuo Matsumoto (AKA Shoko Asathara), this attack offers the United States health care system numerous lessons to be learned in the event of an attack by terrorists using Weapons of Mass Destruction (WMDs) or other mass-casualty events.

Terrorists are willing to kill thousands, kill indiscriminately, and use WMDs. Only small amounts of WMDs are needed to cause mass casualties. Symptoms are difficult to recognize because medical staff are unfamiliar with them. And, health care institutions will be quickly overwhelmed because of the huge patient surge and because victims and the “worried-wounded” will self-transport. First responders and receivers may be contaminated, depleting valuable human resources. Also, a large percentage of “victims” may not actually be infected, but will, in a panic, respond to the nearest health care facility, making it difficult for caregivers to discern between those actually afflicted and those who are psychosomatic.

Consequently, there are a number of steps that communities must take to mitigate, prepare for and respond to mass casualty events caused by WMDs or other mass casualty events. Medical staff must be thoroughly trained to recognize symptoms of WMDs, including nerve agents, smallpox, anthrax and other potential weapons. Hospitals, health departments and first responders must dramatically improve cooperation, and, as U.S. Army Major James Hanlon has said in lectures delivered to students of the University of North Carolina, “We must begin planning for the most catastrophic events now…We need to develop and integrate detection and surveillance capabilities….Equipment such as decon apparatus and personal protective equipment must be addressed (and) issues such as heating ventilation and air conditioning systems and the ability to quarantine large sections or entire hospitals will have to be addressed.”

Again, while this is a terrorist attack from which we draw lessons, many of the structures developed in response to this lesson are also essential for planning for and responding to a pandemic, natural disasters or other man-made events such as mass shootings or infrastructure failings, such as the bridge collapse in Minnesota.

My sense is that hospitals are responding. With new stringent standards from the Joint Commission for hospital emergency management plans and other upcoming changes, along with the adoption of the National Incident Management System and Hospital Incident Command System, hospitals are planning for disasters as never before. Still, the wake-up call has been issued and the public stirred. In response, hospitals would be well-served to give notice to the public they serve that they, health departments and first responders are committed to working together to ensure interoperability and adequate preparedness through funding, ongoing training and other measures.

© The Barrick Report and Emergency Preparedness Today,  2009. Contact the author at mbarrick@charter.net.

An Initiative of Leadership Required

Hospitals must take a lead in emergency preparedness as population shifts to areas prone to natural hazards

By Michael Barrick

This week, the United States Census Bureau reported that 47 of the 50 fastest-growing areas in the United States were in the South and West. This is significant news for hospitals serving those growing populations, for these are the same areas that are among the most likely to experience natural hazards.

What this means is that hospital administrators and emergency managers must exercise an initiative of leadership in planning for the increased mortality, morbidity and financial costs sure to arise from these dangerously merging trends.

This year, the Joint Commission – the independent organization that accredits and certifies hospitals and other health care organizations – has dramatically increased its scrutiny of hospital emergency management plans. And, for 2009, it will likely focus even greater attention on those plans, as it is proposing to take emergency management out of the Environment of Care Chapter and make Emergency Management its own chapter, meaning a hospital’s plans for emergency plans and operations will be on par with the other seven chapters that cover major aspects of hospital clinical and support activities.

These increasingly stringent standards are overdue and should be welcomed. Yet, it may still not be enough if hospitals do not assert leadership roles for disaster planning within these rapidly growing regions. According to the Census Bureau report, communities in Florida, North Carolina, Georgia, Texas, Arizona, California, Louisiana and Nevada were among the nation’s ten fastest growing locations.

So, regions that are prone to natural hazards such as hurricanes, earthquakes, tornadoes, wildfires, and droughts are seeing the greatest population growth. As natural hazards impact these areas, hospitals will be overrun with victims from mass casualty incidents; and, financial losses (property damage, health care delivery costs, and the cost of response and recovery) will increase.

These are hazards that hospitals cannot afford to ignore. Recent disasters caused by naturally-occurring events have proven that “all roads lead to the hospital.” In other words, disaster victims often bypass first responders and transport themselves to the hospital. Yet, for even those that are transported by ambulance, how they get there is ultimately irrelevant – they will get there. So, while other community responders and agencies may be entering the recovery (or final) phase of a disaster, the hospital will find itself in the middle of the response phase – and may for an extended period of time.

It is true that laws in many states mandate that counties or municipalities serve as the primary entity responsible for disaster planning and response. These statutory requirements, however, cannot be used by hospitals as an excuse for not taking an aggressive, leading role in collaborative community planning for natural hazards. Hospitals must be active partners in developing community all-hazards plans that account for population growth – which includes not only more people, but more structures that pose risks in severe weather. They must also take into consideration historical climate data, the identification of available resources, and plans for finding funding streams to meet the shortfalls in needed resources for the inevitable risks caused by these migration patterns.

Obstacles to effective disaster planning, preparedness and response must also be identified, acknowledged and overcome. Much of government funding – especially since the terrorist attacks of September 11, 2001 – has been directed to response agencies. There remains a reluctance among responders and receivers to establish, cultivate and maintain the necessary relationships to understand and work together to complement each others’ roles. Also, the hospital industry is growing increasingly competitive. So, a culture of mistrust between hospitals filters into areas where it should not, such as emergency preparedness. These political, cultural and economic factors must not be allowed to stand in the way of hospitals fulfilling their ethical responsibilities.

Too often, they do. Yet, this is not because of a lack of regulation. In addition to the Joint Commission, the Federal Emergency Management Agency (FEMA) now requires that hospitals demonstrate that they are preparing for and managing disasters utilizing a proven and standardized command structure and system – the Hospital Incident Command System (HICS).

So, while systems are in place that should foster interoperability and standardized approaches for emergency planning and response, their success is dependent upon the people responsible for implementing them. Consequently, those running hospitals must exert an initiative of leadership to account for increasing populations in areas prone to natural hazards. Anything less is a recipe for disaster.

© The Barrick Report, 2008. Michael Barrick works in a hospital in the field of emergency preparedness.

The Major Flaw in the New National Response Framework

FEMA should stand alone

By Michael Barrick

The U.S. Department of Homeland Security (DHS) recently released the National Response Framework (NRF), the manual replacing the National Response Plan (NRP). The NRF is essentially a blueprint for how the nation and its communities will respond to disasters. According to the Fact Sheet distributed along with the news release announcing the new NRF, five principles guide the NRF – engaged partnerships; tiered response; scalable, flexible and adaptable operational capabilities; unity of effort through unified command; and readiness to act.

Well, it sounds reasonable enough in theory. However, a closer reading reveals a major flaw. The Fact Sheet also claims, “The National Response Framework is a guide that details how the Nation conducts an all-hazards approach.” This is the flaw of the NRF. It will not utilize a true “All-Hazards” approach any more than the replaced NRP did. Why? Because the Federal Emergency Management Agency (FEMA) remains under the control of the DHS, which it was integrated into on March 1, 2003.

Consequently, the DHS continues to ignore the key lessons we should have learned from Hurricane Katrina. The lesson – the nation’s “All Hazards” approach is a misnomer. DHS has been focused almost exclusively on terrorism, while our nation’s communities are more likely to experience emergencies caused by natural disasters, man-made events and infrastructure deterioration.

FEMA should stand alone. Not all emergencies are homeland security issues. DHS funding decisions since the terrorist attacks of September 11, 2001 are the best evidence that the DHS has not truly employed the “All Hazards” approach. From New York to villages in the Appalachians and sparsely-populated states in the Western U.S., money has gone to equipment and supplies primarily geared towards terrorism. This approach, weighted heavily and inappropriately towards terrorist threats, has robbed communities of not only desperately needed resources for more realistic and common hazards, but has also distracted our focus. While all levels of government should not ignore the reality that we are at war, history and experience have proven that natural disasters, man-made events and infrastructure challenges will dominate our emergency preparations and responses.

Consequently, the NRF is just as likely to fail as the NRP. FEMA must be removed from the Department of Homeland Security (DHS). In doing so, DHS could apply the “All Hazards” approach in the context of war and FEMA could apply it in the context of realistic hazards for which it is more suited to plan for and respond to. State and local governments should continue working with both agencies in an integrated fashion to ensure interoperability, but should also be free to focus on more common hazards.

Proof of this is how the NRP and the people responsible for implementing it failed to prepare for and respond to Hurricane Katrina. Though countless words have been written about the response to and aftermath of Hurricane Katrina by journalists and all levels of government, A Failure of Initiative: Final Report of the Select Bipartisan Committee to Investigate the Preparation for and Response to Hurricane Katrina offers the most comprehensive and compelling evidence that the National Response Plan (NRP) was an abject failure in meeting the needs of the citizens impacted by Hurricane Katrina in Louisiana (as well as Mississippi, Alabama and those areas to which residents were evacuated and relocated). More precisely and accurately, however, it was not the plan that failed. Rather, it was the people charged with implementing the plan that failed. There is no reason to believe that this would change with the NRF for two reasons. First, because of the continued inclusion of FEMA under the DHS; and also because of the government’s reluctance to hold people accountable for failure – regardless of what plan or framework under which they operate.

Hence, we must consider the lessons learned from Hurricane Katrina from not only a systematic perspective, but also with a critical view of the failure of people to do their jobs to protect and save lives and property. While the congressional report cited above points to numerous shortcomings, virtually all of them can be traced to the failure of emergency preparedness officials to embrace the fundamentals of emergency preparedness as outlined in the NRP. There is nothing in the new NRF to make one think that a “new” framework will change that.

The NRP was a failure because the people charged with knowing and implementing it failed to utilize it as designed. Though it is characterized as being “always in effect,” it clearly was not. And, the respective governments responsible for knowing and implementing the NRP essentially failed to hold individuals accountable (with a few notable exceptions).

As a result, the national morale was and remains severely harmed. That will not change until we acknowledge that FEMA should not have been integrated into DHS and should be immediately separated from it.

Evidence of the NRP being essentially ignored is overwhelming. A fundamental precept of emergency planning and management is that there are four areas of emergency planning – mitigation, preparedness, response and recovery. Steps that could have been taken to mitigate the impact of the storm were not. Those charged with preparedness essentially stood on the sidelines, waiting for landfall. Consequently, response efforts were severely hampered. Recovery is ongoing. That the 9^th Ward of New Orleans still today looks like Katrina blew through yesterday, and the fact that tens of thousands of families remain sheltered in mobile homes are two startling examples of failed recovery efforts.

The NRP called for coordination among all jurisdictional levels, flexibility in response, and for emergency officials to anticipate a threat. None of these things occurred as the plan required. The NRP had called for all levels of response and recovery agencies to implement the National Incident Management System (NIMS). Many had not. Those that had were dealing with officials completely unfamiliar with its structures and purpose.

Evacuation orders were issued far too late and private agencies, such as hospitals, were left to stand alone for days without utility services in stifling conditions in the midst of civil unrest. Healthcare workers and hospitals are still being sued by families convinced that their family members died needlessly – and perhaps even at the hands of those charged to protect and preserve them – because conditions were so horrendous and dangerous that nothing these healthcare workers learned in school or through years of practice could have prepared them for the conditions in which they found themselves.

So, indeed, the first three words of the congressional study – “A Failure of Initiative” – point to the root cause of these multiple failures. In short, the system failed because people failed.

How then, should we respond?

People must be held accountable. Complacency and mediocrity are the inevitable result of the generic “mistakes were made.” Lessons learned are meaningless if those responsible for making the mistakes escape the consequences of their inaction or incompetence. This is a tendency that must be eliminated. Where people fail to do their jobs, we can react in one of two ways. First, we can conclude that those responsible have learned their lessons and have become stronger and better prepared as a result, and hence should be retained and allowed the opportunity to demonstrate they can be entrusted with future risks. In some cases, however, it must be acknowledged that the mistakes or negligence were so egregious as to rise to the level of “dereliction of duty.” In those cases, people must be removed to prevent further loss of life in future events, and to serve as an example that some errors are so great that if those charged with protecting citizens don’t do as required of them, they lose their jobs – and may even be prosecuted.

Corrective Action Plans require responsible parties, as well as clearly articulated expectations and deadlines. Without ownership and follow-up, no actions will be taken. Training and repetitive drilling is essential. People must learn systems and learn cooperation. That can’t be done in the absence of training, drilling and networking.

Until FEMA is removed from the DHS, no plan, framework or any proposal – regardless of the name – will ensure that those responsible for protecting the lives and property of Americans, whatever the threat, will succeed.

© The Barrick Report, 2008. To contact the author, write mbarrick@charter.net

Retiring ‘Bubba’: The Imperative for Professional Emergency Managers through National Accreditation

By Michael Barrick

In late 1973, at the age of 17, I worked my first shift on an ambulance in rural Doddridge County, W.Va. As the fates would have it, before I had even completed my training as an Emergency Medical Technician, I was faced with the prospect of delivering a baby. Fortunately, mom had been there – seven times before. So, she guided me and my equally green partner (and best friend) through the process.

Much has changed in the passing 35 years. The world in which we live is far more complicated and clearly more dangerous. Consequently, just as I was over my head in the back of that ambulance then, so too are many within the Emergency Management sector today. This is not an indictment of folks who I classify collectively as “Bubba.” Rather, several factors – rapid technological change, systems thinking, media savvy, public policy, political pressures, decision-making skills, and a world that does not have the luxury for turf battles – demand that we abandon the old ways of preparing for and responding to disasters, whether natural or man-made.

That means that it is time to retire “Bubba” and replace him with expertly trained emergency managers through National Accreditation.

Just recently, Chairman Arnold Punaro of the Commission on the National Guard and Reserves told the Associated Press that roughly 90 percent of the National Guard and Reserve units in the United States are not prepared for an attack upon the United States homeland. Commenting upon this frightening scenario, Punaro said, “…in the world we live in – you’re either ready or you’re not.”[1]

The same is true with Emergency Management. While some efforts have been made to address this deficiency – most notably the establishment of the National Incident Management System (NIMS) – much work remains. Consequently, it is imperative that steps be taken immediately to increase the professionalism of emergency managers through formal education, specialized training, professional certification and salaries commiserate with the heady responsibilities essential for leading all levels of government to prepare for and respond to disasters as the American public has come to expect and deserve. A glaring example – the response to Hurricane Katrina – only underscores this need.

Claire B. Rubin addresses both the deficiencies in current emergency management practices, and more importantly, the challenges facing the field which have created the deficiencies. Speaking to the most notable change in our lifetime – the rise of Al Qaeda – Rubin notes, “Unfortunately, their brand of terrorism is likely to plague the world for generations.”[2] Additionally, she noted the challenge of finding the proper niche for the U.S. Department of Homeland Security (DHS), saying, “…problems with implementation of the programs and activities of DHS will probably provide topics for research and discussion for decades.”[3] Noting that public health officials, in particular the U.S. Centers for Disease Control also face new challenges, Rubin acknowledged, “…the growing importance of the health and medical aspects of threats and disasters along with the essential need for the emergency management community to create or improve working relationships with their health and medical counterparts.”[4] In short, as she noted, “The relationship between homeland security and emergency management remains to be worked out at every level of government.”[5]

These challenges can only be addressed by a cadre of professionally trained emergency managers. Why? The reasons are numerous. Because emergency management agencies are largely political entities, the ability to negotiate the intricacies of political debates and turf battles requires people with the skills to negotiate the political process while relentlessly fighting for resources, assets and flexibility. Otherwise, we will remain as our military is now – not ready! As noted, flexibility is essential because circumstances are changing so rapidly. Our representative “Bubba” is generally inflexible. A rapidly changing environment requires constant education. So, people responsible for emergency management must be able to manage their jobs while also being willing to constantly train and learn. Again, those resistant to change will fail in this environment. The advent of NIMS demands a change in thinking – both among first responders and first receivers, such as hospitals. This requires systems thinking and problem-solving skills that are not dogmatic. Management by Objectives demands adaptability. Those who won’t change as circumstances warrant present a danger to the public they wish to serve.

Turf battles must end. The first and most important characteristic of a leader is a servant nature and attitude. While a leader must be willing to “take charge,” he or she must also be willing to share power and knowledge. Those accustomed to holding on to knowledge because it means they hold on to power put the public at risk.

The emergency managers of the future – of now, really – must embrace strategic thinking and systems approaches. They must demonstrate the ability to learn quickly and discard old thinking when proven to be outdated. They must be able to learn and utilize the latest technology. They must understand the role of the media and be able to communicate through them without developing an adversarial tone. They must understand legal issues, to embrace life-long learning, and make quick decisions without expecting a medal for simply doing their job.

All of this means that it is time to retire “Bubba.” Otherwise, we’ll be waiting for his funeral. If we do, we are risking that our own funerals may be held at the same time.

© Michael Barrick, 2008.

NOTES

1. “Military unready for homeland attack, says study,” Associated Press, 2 February 2008 [Online] <http://www.cnn.com/2008/US/02/01/guarding.america.ap/index.html>

2. Claire B. Rubin, “Emergency Management in the 21^st Century: Dealing with Al Qaeda, Tom Ridge and Julie Gerberding,” “The George Washington University Institute for Crisis, Disaster and Risk Management” and “The Natural Hazards Center, the University of Colorado, Boulder,” May, 2004, p. 3.

3. Ibid.

4. Ibid.

5. Ibid, p. 4.

 

BIBLIOGRAPHY

“Military unready for homeland attack, says study.” [Online]. Associated Press, 2 February 2008.

Rubin, Claire B. “Emergency Management in the 21^st Century: Dealing with Al Qaeda, Tom Ridge and Julie Gerberding.” “The George Washington University Institute for Crisis, Disaster and Risk Management” and “The Natural Hazards Center, the University of Colorado, Boulder.” May, 2004.